Welcome

Welcome to the POZ/AIDSmeds Community Forums, a round-the-clock discussion area for people with HIV/AIDS, their friends/family/caregivers, and
others concerned about HIV/AIDS. Click on the links below to browse our various forums; scroll down for a glance at the most recent posts; or join in the
conversation yourself by registering on the left side of this page.

Privacy Warning: Please realize that these forums are open to all, and are fully searchable via Google and other search engines. If you are HIV positive
and disclose this in our forums, then it is almost the same thing as telling the whole world (or at least the World Wide Web). If this concerns you, then do not use a
username or avatar that are self-identifying in any way. We do not allow the deletion of anything you post in these forums, so think before you post.

The information shared in these forums, by moderators and members, is designed to complement, not replace, the relationship between an individual and his/her own
physician.

All members of these forums are, by default, not considered to be licensed medical providers. If otherwise, users must clearly define themselves as such.

Forums members must behave at all times with respect and honesty. Posting guidelines, including time-out and banning policies, have been established by the moderators
of these forums. Click here for “Am I Infected?” posting guidelines. Click here for posting guidelines pertaining to all other POZ/AIDSmeds community forums.

We ask all forums members to provide references for health/medical/scientific information they provide, when it is not a personal experience being discussed. Please
provide hyperlinks with full URLs or full citations of published works not available via the Internet. Additionally, all forums members must post information which are
true and correct to their knowledge.

Author
Topic: State Laws Are Contributing to the Spread of HIV and AIDS (Read 23963 times)

That's not entirely true! Google Free Breast Cancer screenings as an example, and you'll find a number of various sites and programs for those who qualify. There are different eligibility requirements on a lot of em depending on what state you are in or what program you look into.

I'm definitely not thrilled with the patchwork of programs and people being left allowed to follow through the cracks either.

Still, I don't think not knowing your HIV status is a good idea simply because the programs out there are flawed and underfunded.

Unfortunately these tests are routine only for those that are insured or those wealthy enough to afford them.

Thank you.

Those tests are encouraged by media and the medical field, but one doesn't have to do them. My mom, who's grandmother, mother, and all aunts had breast cancer, refused to have a mammogram for years. Cost wasn't the issue, fear was. I dare say not much different than the fear many have concerning being tested for HIV. Don't get me wrong I know it is important to know your status. But how is encouraging routine testing any different from what we are doing now.

Still, I don't think not knowing your HIV status is a good idea simply because the programs out there are flawed and underfunded.

Wesley, I really get what you say and hope you understand that. But what are we going to do with the influx of thousands and thousands of newly diagnosed cases, most of which will be with out insurance, on an HIV health care system that is already strained. Yes it might help lower the infection rate, but we must be prepared for the problems associated with the outcome of routine testing.

Logged

"Let us give pubicity to HV/AIDS and not hide it..." "One of the things destroying people with AIDS is the stigma we attach to it." Nelson Mandela

Last time I checked, Oraquick was $14.00 a pop, and only if you buy more than 400. Any less and the price rises to about $19.00.

Now, if this is done in emergency rooms, the price would rise to about $140.00.

We can moralize about testing, counciling, treatment and any number of issues, but if you don't take care of the $$$$$$$$$$$$$$$$ first, nothing is going to happen.

Since we are spending $2,000,000,000 (billion) a week in Iraq, there is little chance that the Federal government is going to fund such a plan, nor will the states who are doing everything possible to keep from having all their bridges fall down.

I humbly offer that until tens of thousands show up in emergency rooms with full out PCP, then nothing will be done. Haven't any of you read the history of this disease? Under our dear Ronnie Raygun, 50,000Hemopheliacs and Gay people had to die before that son of a bitch even said the acronym AIDSor HIV in public! Does anyone think the self described "War President" could give a shit about HIV/AIDS domesticallly? Why have all his AIDS directors been Baptist Ministers? GEEZ Austin, wake up please; reason has left the planet for the time being.

Let us please get real in this discussion.

Love,

Logged

The Bible contains 6 admonishments to homosexuals,and 362 to heterosexuals.This doesn't mean that God doesn't love heterosexuals, It's just that they need more supervision.Lynn Lavne

OMG Are you people serious I can't believe that you would suggest that until thousands of people show up in emergency rooms with full out PCP, then nothing will be done. Are suggesting that we do nothing and just wait till thousands of people are dying because it cost to much to test them. You can't possiblily think that the best way to handle this is to do nothing. How will waiting till thousands of poeple flood ER's with full out PCP going to save money.

Yes there will be thousands of new cases. Millions in fact!!! but does that mean that they should not know they have HIV. I should think not. Such thinking is simply absurd. Ignorance is NOT the solution, It IS the Cause Ignorance is NOT bliss, It is DEATH Death for those who don't know they have and Death for those who they will infect.

We may not have the money to treat every new case of HIV but why should lack of funds be an excuse for people not knowing thier status. Does any one think that people not knowing thier HIV status is going to make thinks better or stop the spred. If I were a man who could be left speachless I surely would be at this point.

I am astounded that so many people with HIV would NOT support making HIV testing a standard test. Had any of you known that the person you got HIV from had been positive would you have engaged in the activity that infected you. If they had known they had HIV do you think they would have given it to you. Knowing one's status is the first step in brining this to an end. If one thousand or one million new cases are found then we will find the money to treat them when they need it. Just because a thousand new people test Positive today it does not mean that they will need treatment tomorrow. They could go many years before they need treatment. However waiting till they are all on thier death beds will only add to the cost.

OMG Are you people serious I can't believe that you would suggest that until thousands of people show up in emergency rooms with full out PCP, then nothing will be done. Are suggesting that we do nothing and just wait till thousands of people are dying because it cost to much to test them. You can't possiblily think that the best way to handle this is to do nothing. How will waiting till thousands of poeple flood ER's with full out PCP going to save money.

However waiting till they are all on thier death beds will only add to the cost.

Mike,

First off, I am one of the few here who has brought up the $$$$$$$$$$$$$$ subject and that was because Austin stated that 30 some states refuse to act on the CDC "suggestion" that the states do universal testing. I merely stated the obvious in this time of huge holes in most states budgets.

Now on to the rest of this statement. I have been in HIV activism since 1979, and screaming for universal testing since the test was created in 1985. How does that weigh in your admonition that I wake the fuck up and advocate universal testing??? I have run two HIV/AIDS service and education organizations and have yet to see the goals we have advocated for almost 25 years now; be adopted by this sleepwalking nation. My present service area is about 13,000 square miles, about half the size of Vermont and I only work the southeast corner of this vast state. One of the AMG guests motored across this great state and saw the scattered population over miles and miles of countryside. I would really like to have a tangeble suggestion to give to the next HIV/AIDS State Advisory Council how we can get our REPUBLICAN State Legislature to mandate and fund universal testing in all the corners of this very large state. I would suggest you do your homework on some of the posters on this site before your fingers do the walking.

Now for the last point. How do you ENFORCE universal testing, when I just came home from an AIDS Walk planning meeting for our second annual AIDS Walk in this southwest, mormon, cowboy hick town in southeast Arizona and I was admonished by two very astute and active HIV women who have jobs in our county to leave the condoms at home, because they have been warned that if any more kids get condoms from their stash that they will be fired. One of these women has been an activist since she lived in New York City in the 1980's.

You are so very well versed in the ENFORCEMENT OF THE CONCEPT OF UNIVERSAL TESTING, I anxiously await your learned advice on how I should proceed.

This is one of the reasons I have been so very quiet lately, because I always get myself in trouble with some new person on these boards who call me out, I get pissed and react, and then I get timed out. I also await my warning from the moderators, so fire away Mike from Vermont.

Love,

« Last Edit: October 12, 2007, 07:10:47 PM by Moffie65 »

Logged

The Bible contains 6 admonishments to homosexuals,and 362 to heterosexuals.This doesn't mean that God doesn't love heterosexuals, It's just that they need more supervision.Lynn Lavne

Wesley, I really get what you say and hope you understand that. But what are we going to do with the influx of thousands and thousands of newly diagnosed cases, most of which will be with out insurance, on an HIV health care system that is already strained. Yes it might help lower the infection rate, but we must be prepared for the problems associated with the outcome of routine testing.

Well, I would hope that we would help them. Even just knowing a status is beneficial to take other measures even until such time all could be treated.

Frankly, I'm not even going to address the ridiculous other suggestions that we just wait until people rot and die. It frightens me that some who claim to be such long time advocates have such apathy and beyond.

I think I'm a pretty down to earth person and I don't even know how to address the idea that I'm from another planet or whatever that mess was.

I've dealt with non profit organizations and been very involved in certain organizations related to cancer and some with HIV. I don't need to boast about my alleged credentials further, but I realize people can get burnt out, become apathetic and self serving, but to me this is just shocking!

I am not suggesting any one person here, but the people who do obviously care about their fellow men and women have saved the day for me and my wild ideas that we can make progress.

Frankly, I'm not even going to address the ridiculous other suggestions that we just wait until people rot and die. It frightens me that some who claim to be such long time advocates have such apathy and beyond.

I think I'm a pretty down to earth person and I don't even know how to address the idea that I'm from another planet or whatever that mess was.

I've dealt with non profit organizations and been very involved in certain organizations related to cancer and some with HIV. I don't need to boast about my alleged credentials further, but I realize people can get burnt out, become apathetic and self serving, but to me this is just shocking!

Don't know how to address posts others have made in this thread, you say? Sure you do...with the same old back-handed & passive aggressive jibes you've always used. Comments about being burnt out, apathetic and self-serving...things like that. I don't believe background was provided to "boast" as you say about "alleged credentials", but to provide a frame for context.

Jesus H. Particular Christ! Did any of you even READ what was posted above? Hello?!

Whatever else might be said of the poster to which you refer, one claim that CANNOT be leveled is that this poster is apathetic. And at no point was the it suggested that waiting for people to rot and die was the correct course of action- just the one that was most likely to take place. And I'm sorry, but history backs that position up. And to this person's credit, it was also not said that you (Austin) were from another planet- it was stated that REASON has left the planet for the time being.

There seem to be two separate discussions going on here. One involves a lot of hand-wringing and moralizing. The other involves some bare-bones facts. I don't see that any line can be drawn in this thread giving one side claim to the title of those who "do obviously care about their fellow man".

Do you even have a thought on the topic or are you just here to trash people like Wesley and those who might agree with his thoughts on the subject. I mean if you have an opinion on the topic I am sure we would love to hear it. But honestly this petty gripping is only serving to discredit you. Please deal with the topic and leave the personal trashing for a PM.

I really hope that we can get back to the topic and hear some honest thoughts on it. I think we were trying to discuss the pro's and cons of this routine testing.

Do you even have a thought on the topic or are you just here to trash people like Wesley and those who might agree with his thoughts on the subject. I mean if you have an opinion on the topic I am sure we would love to hear it. But honestly this petty gripping is only serving to discredit you. Please deal with the topic and leave the personal trashing for a PM.

I really hope that we can get back to the topic and hear some honest thoughts on it. I think we were trying to discuss the pro's and cons of this routine testing.

I don't give a rat's ass how far my line of credit extends with you. I really and truly don't.

The suggestion that Moffie put forth (and that I share) has nothing at all to do with the moral correctness of universal testing, but everything to do with the financial realities behind it.

And if that hasn't gotten through by now, you're slower and thicker than any syrup your state has ever produced.

I recommend you follow your own advice and reread the posts above without inserting yourself too much in them.

One thing which we haven't discussed is how the horrible meth problem contributes to the spread of HIV. It's really unfortunate and I hope people will put their meth pipes down and listen.

I know I did and I'm glad. I really do feel for those others still apparently struggling with it!

Wesley

WTF? Where the fuck did all that come from? What possible tie does that have to the topic at hand?

Oh. Oh, wait...I get it. You're like trying to suggest that anyone who hasn't walked in lock step with you is some meth addled mess, right? That's supposed to be another one of those snarky passive aggressive things, isn't it?

Everytime someone suggested mandatory testing in the 80s or 90s they were branded a nazi or fascist by aids groups and those on the left. I believe most politicians are afraid to even touch this issue. The left said this was a slippery slope that would lead to further discrimination and possible internment of all hivers. No politician is his right mind is gonna touch this for fear of being smeared again. Another problem is the small number of US deaths from Aids as compared to other causes and diseasesIt might even be fair to say that US hiv is falling off the radar of many. The death rate from AIDS in the US in 2005 was estimated around 17000. Its hard to find AIDS on most charts for causes of US deaths. Maybe when they say AIDS or HIV is manageable they are really talking about it being manageable for the politicians.

Are you people serious I can't believe that you would suggest that until thousands of people show up in emergency rooms with full out PCP, then nothing will be done. Are suggesting that we do nothing and just wait till thousands of people are dying because it cost to much to test them. You can't possiblily think that the best way to handle this is to do nothing.

Frankly, I'm not even going to address the ridiculous other suggestions that we just wait until people rot and die. It frightens me that some who claim to be such long time advocates have such apathy and beyond.

This is precisely how flamewars start in these Forums.

I fail to read Moffie's comment to mean that he is defending apathy until tens of thousands of PCP cases are diagnosed through emergency rooms. Moffie made it quite clear that he supports the idea of universal testing, but is also pointing out the grim reality of things -- that the infrastructure simply isn't in place to do what the CDC REALLY wants here: not only to make testing available to everyone, but to link newly diagnosed people to the medical and social services they need to keep themselves healthy (and, consequently, reduce their risk of transmitting their infection on to others). And what's missing here are funding mechanisms and the infrastructure to provide these necessary services. Moffie's point here is that some states may not realize that it's likely cheaper to implement universal testing and linkage to HIV primary care until scores of late-diagnosed people start racking up insane hospital costs.

Quite possibly, state healthcare systems WON'T realize what a good deal universal testing and linkage to preventive care and treatment is until they're once again shelling out billions of dollars to care for thousands of HIV-positive people who don't present until they require costly hospitalization and critical care. How anybody could think that Moffie -- or anyone else here, for that matter -- is advocating this or defending this is beyond me. This is simply pointing out a grim -- and likely -- scenario that needs to be dealt with. Mike, where does Moffie imply that the "best way to handle this is to do nothing?" Wesley, where does Moffie suggest "that we just wait until people rot and die." Quite frankly, you're both accountable for denigrating this discussion with such disingenuous and intentionally misinterprative comments.

Okay, so we do away with comprehensive pre- and post-test counseling on the assumption that HIV isn't -- or at least shouldn't be -- as stigmatizing as it was back in the 80s and early 90s. Fine. But I'm willing to bet every penny that I have that there will be a fierce resurgence of stigma if all we're providing are test results without linkage to the support and services A LOT of HIV-positive people need. Fact is, the universal testing guidelines are primarily aimed at emergency departments that -- even in this day and age -- are the place where a lot of disenfranchised people receive their primary care. They enter an E.D. for, say, an abscess... agree to be tested for HIV... find out they're positive... and end up being discharged from the E.D. without being directly handed over to medical and social service providers because such programs are already overburdened and simply unable to take on additional patients. You want to talk about stigma? So they've found out they're likely positive, armed with nothing more than a sheet of paper suggesting that their OraQuick assay results need to be confirmed and their fears and anxieties. Unless the Ryan White titles, Medicaid, and Medicare have concrete funding mechanisms in place to pay for the direct-linkage-to-care services that are so desperately needed, it's no wonder that state Departments of Health and legislatures and dragging their feet adopting this CDC mandate.

Another supporter of unversal testing who realizes that there are a hell of a lot of kinks to work out before it becomes a workable option,

ps: And many thanks to Mr. Tim Horn for an appropriate summary of this thread and it's somewhat disingenuous machinations in various postings, as well as a more than generous dash of sane realism regarding the actual topic, in a thread I've studiously read but studiously avoided posting in.

ps: And many thanks to Mr. Tim Horn for an appropriate summary of this thread and it's somewhat disingenuous machinations in various postings, as well as a more than generous dash of sane realism regarding the actual topic, in a thread I've studiously read but studiously avoided posting in.

Okay, so we do away with comprehensive pre- and post-test counseling on the assumption that HIV isn't -- or at least shouldn't be -- as stigmatizing as it was back in the 80s and early 90s. Fine. But I'm willing to bet every penny that I have that there will be a fierce resurgence of stigma if all we're providing are test results without linkage to the support and services A LOT of HIV-positive people need. Fact is, the universal testing guidelines are primarily aimed at emergency departments that -- even in this day and age -- are the place where a lot of disenfranchised people receive their primary care. They enter an E.D. for, say, an abscess... agree to be tested for HIV... find out they're positive... and end up being discharged from the E.D. without being directly handed over to medical and social service providers because such programs are already overburdened and simply unable to take on additional patients. You want to talk about stigma? So they've found out they're likely positive, armed with nothing more than a sheet of paper suggesting that their OraQuick assay results need to be confirmed and their fears and anxieties. Unless the Ryan White titles, Medicaid, and Medicare have concrete funding mechanisms in place to pay for the direct-linkage-to-care services that are so desperately needed, it's no wonder that state Departments of Health and legislatures and dragging their feet adopting this CDC mandate.

Another supporter of unversal testing who realizes that there are a hell of a lot of kinks to work out before it becomes a workable option,

Tim Horn

Hey Tim,

I appreciate you bringing the topic back on track. I do respectfully disagree that routine testing would somehow bring back the stigma and stereotyping that existed in the 80s. I think it's entirely possible that if we ignore routine testing and only target perceived "high risk" groups that we could see something like the 80s with our hospital and healthcare systems overtaxed by a whole influx of undiagnosed people taking up hospital space and resources.

I fully realize our medical system is flawed and underfunded, but I previously mentioned several scenarios as to why I feel that routine testing if done properly could and would save lives and money by keeping people healthy. Believe me, you aren't going to get an agrguement from me that this patchwork of private and public medical care in this country is perfect.

It's my opinion that routine testing would actually help in the long run to break down stigma and stereotypes. Many of the previous "high risk" groups are still the primary focus of prevention efforts while new high risk groups are quickly forming. HIV is now rapidly increasing among our senior population and many other demographics that were previously ignored.

I think there has been some confusion over the difference between "routine" and "mandatory" HIV testing. I want to make it clear that I'm in favor of routine testing not mandatory.

Whether counseling is available to everyone or not I still feel that routine testing should be available and I think it would help end some of the stigma and breakdown those stereotypes that only gay men and drug users are the only ones who get HIV. Obviously, women are a high risk category and many ethnic groups and minorities who go largely ignored still.

I don't think doctors and clinicians should have to fill out reams of paperwork and provide pre diagnosis counseling just to do a simple blood test to confirm an HIV diagnosis. Even still in the medical community those old stereotypes play a large role as people continue to go undiagnosed and misdiagnosed because they don't fit some perceived "high risk" group.

My opinion is that to get a better handle on this epidemic and acquire adequate funding we should help push those hold out states towards routine testing. I think it will help breakdown the stigma and stereotypes if we have a very accurate breakdown of the demographics representing everyone who's HIV+ while simultaneously preventing further infections!

Perhaps we can clear up some terms that may help to keep us all on the same page here. I have seen the terms “mandatory testing”, “Universal testing”, “Routine testing” used.

Mandatory testing, would rightly so, imply that all people be tested like it or not. This is not the intent of these guidelines nor the suggestions of them.

Universal testing, would to me, imply that all people who seek medical attention be given an HIV test with or without consent. Again this is not the intention of these guidelines.

Routine testing, would imply that an HIV test be done as part of routine testing . Now as with any “routine test” be it a Hep screen or CBC panel or HIV test the Patient has the right to refuse or opt-out of the test. By terming the HIV test as a “routine test” this allows the test to be done without a special consent form(s). That is it would fall under the general consent form all people sign. People would still be told that an HIV test is being ordered but it would become part of routine tests thus diminishing the stigma associated with an HIV test and eventually (hopefully) to relieve the stigma of HIV altogether.

On the point of funding. I have heard time and time again how funding for “universal” testing is just not there. I think it could be. I know it could be, (just a point of reference) if we can find $400 million a day to fight another countries civil war, then surely we can find the money to test people for HIV, and to offer the counseling they want and or need. These guidelines don’t require medical services to be the sole source of counseling, CBO’s and ASO’s are considered acceptable sources for any needed counseling. I will concede that ASO’s are funded on the number of HIV clients they have, thus it would stand to reason that if more people are getting tested and testing positive that more funding would be made available.

I can only see many of these recommendation as a way to help mainstream an HIV test and destigmatize an HIV diagnoses. I would hope that all of us would welcome the day when saying “I have HIV” was no more likely to cause fear or isolation than saying “I have Cancer”. This could be a step in the right direction, and I think it is. Nothing new is without it’s flaws, but I don’t see that waiting until all the flaws are solved is the way to bring the spread of HIV to a halt. Only through people knowing that they have HIV can we hope to educate them and begin to truly make a difference in stopping new infections. If one does not know they have HIV then they don’t know they are spreading it to others. Surely this is common sense. Society is not blaming the people who don’t know they are positive for the spread of HIV, they are blaming the ones who do know. I have to believe that if more people knew they had HIV less people would be spreading it. Make no mistake I am NOT saying that only people who do Not know they are positive are the cause of HIV being spread. I know full well that there are some out there who do know they have it and continue to carelessly spread it. My point is That the best way to bring about change is through the knowledge of ones status.

as usual,I am attacked for stating a fact. I did not say that Hivers and the lefts fears were unfounded or without merit, I simply stated that in 80s and 90s whenever someone suggested mandatory testing they were smeared and attacked. I did not say that I didnt benefit from Aids activists. I did not call anyone a fag.Fear of smear and the small amount of deaths from HIV, compared to other causes of death means no one in politics senses any need for mandatory testing.As a person with HIV I am very happy we weren't rounded up or interned in the hysteria and panic of late 80s and early 90s, but I always think its interesting to wonder what something like that would have done to the spread of HIV in the US.

To not test all for fear of a return to stereotypes or stigmas is not a good reason. We don't wanna know who may have HIV because we are afraid of creating stigma for those already infected? Sorry, but thats not a valid reason if you are really interested in stopping HIV. What is more important, the quality of life of those already infected or stopping new cases of HIV? Lets just put our heads in the sand maybe the problem will go away. Should those of us who were stupid enough to get this virus be the right persons to decide how to stop the spread of it? Maybe, but not if we our main concern is stigma and stereotypes.

A universal health care or government administered health care system(is that the same thing?) will mean health care rationing. Any time a government attempts to control markets or prices, rationing of some form will occur and black markets are created to solve the problem. What happens ten years from now if we have National Health care and some republican,who as we all know want all gays to die, becomes President or they control the congress and they make a decision certain treatments or drugs are gonna be just too expensive for patients or even to be developed? Its going to be fun. Instead of the market and insurance companies determining how and what people are treated with,those who have political power will be making those decisions. So is it possible if you decrease the number of people with HIV,that patient group will lose what little political power it has now and those already infected will be told they are just too expensive to treat? In fact since testing is so expensive,wouldnt it be cheaper just to let people live in ignorance and maybe they will just die and save us the cost of drugs?

What happens ten years from now if we have National Health care and some republican,who as we all know want all gays to die, becomes President or they control the congress and they make a decision certain treatments or drugs are gonna be just too expensive for patients or even to be developed? Its going to be fun.

Gee I wonder? What WOULD it be like to have Republicans control the White House and Congress? I guess we'll never know. Of course we know Republicans don't want all gays to die, if they did there would be no Republican Party.

I admit that my statement to Mikey was done in frustration, and also probably just a bit of anger...... I felt my statement to him let him know that I was finished, and couldn't get through to either him or Austin. That being said, if I were in your shoes, I would have also given me a warning. I apologise for not keeping my emotions in check in this very important discussion.

Rev. Tim,

Thanks for your very pointed post which tries also to explain one of the least discussed issues in HIV/AIDS work in this capitalist democracy. I truly appreciate your efforts.

Tim Horn,

Your non emotional, clear description of the real issues that are the back story of "why 30 states have not fallen into lock step with this very unusual government" really helps to define the reasons why these suggestions from the CDC are not being followed. I thank you.

Now for the comments that inspired this post, I find that some of the posters have created "facts" that are at the very least, misleading and I feel compelled to make comment before this thread drops into infinity.

Mike said this:On the point of funding. I have heard time and time again how funding for “universal” testing is just not there. I think it could be. I know it could be, (just a point of reference) if we can find $400 million a day to fight another countries civil war, then surely we can find the money to test people for HIV, and to offer the counseling they want and or need.

I nor anyone else I have worked with in HIV have ever suggested that the money couldn't be found, we all know that this is very true, and not a question in the richest country on the planet. Then he follows up that assertion with "I think it could be". Yes, it could, but just how is that going to happen in a Capitalistic driven health care system, without government intervention? Mandates from the government are never followed without the attendant funding for such edicts, NEVER. I don't care if it is pollution in California or edicts in the healthcare system, it just doesn't happen.

Then this:These guidelines don’t require medical services to be the sole source of counseling, CBO’s and ASO’s are considered acceptable sources for any needed counseling.

I don't know how things work in Vermont, but I do understand Ryan White, and I know that seldom do Doctors working in private practice who are not Infectious Disease Specialists, interact with AIDS Service Organizations. I also know that counseling services and mental health counseling are one of the six mandated line items required before any state can be funded for Ryan White contracts, but still, I have almost never seen doctors in private practice work in parallel with most ASOs. This would add so many cumbersome issues to the mix for the newly diagnosed that many would go running into the bush just to get away from this suggestion.

Finally on this issue, AIDS Service Organizations are not automatically funded for testing at all, because Ryan White funding comes from HHS, which is the "services" side of the National Institutes of Health. The CDC is the source for Testing and post test Counseling. These monies are two very separate funding streams, and only recently, (in the last month) has there ever been any attempt to have these two very separate funding streams to be joined for better communication and more complete coverage of the needs. When an ASO wants to be funded for testing and counseling, they must apply to their state's governments for that funding, which then comes out of the Prevention funding grants from the CDC to the individual states. It is very dangerous to all of our understanding to make blanket and vague statements about funding HIV/AIDS services in the United States, because if you don't know the details, then you miss out on ever solving the real issues, including Testing and Counseling.

And then this very misleading statement;I will concede that ASO’s are funded on the number of HIV clients they have, thus it would stand to reason that if more people are getting tested and testing positive that more funding would be made available.

What he states here is true to a point. No ASO is automatically funded and the states must now apply for new Ryan White Contracts every three years. In that length of time, each year ASOs also have to apply to the States individual HIV/AIDS programs through their own state Department of Health. They are funded X number of dollars for each client and as the client base grows they are funded each year for their increase in client load depending on the amount of money left in the budget for the three year span. It is not automatic that the monies will magically arrive based on the numbers of new clients, and many states have sustained, and still do, waiting lists for not only drugs but for services. Waiting lists are a subject that we in the field never thought would come about, but the fact is, this current administration has raped the Ryan White funding through their policy of flat funding, for nearly seven years now. His statement assumes a caring government, a well oiled HIV program for every state, and in the end, it just isn't true! Also it is very important to remember that not all states have a huge population of ASOs, and those states use Ryan White through their states Health Departments because that is the final stop for HIV money coming from HHS. Ryan White legislation mandates that the states search out all qualified Nonprofits to take the funding, but in some states, this just is not the case due to the lack of Nonprofit ASOs and in the end the programs are integrated into the Counties' health departments. These states usually have far higher spending and far fewer real dollars for their clients.

And finally:

I can only see many of these recommendation as a way to help mainstream an HIV test and destigmatize an HIV diagnoses. I would hope that all of us would welcome the day when saying “I have HIV” was no more likely to cause fear or isolation than saying “I have Cancer”. This could be a step in the right direction, and I think it is. Nothing new is without it’s flaws, but I don’t see that waiting until all the flaws are solved is the way to bring the spread of HIV to a halt. Only through people knowing that they have HIV can we hope to educate them and begin to truly make a difference in stopping new infections. If one does not know they have HIV then they don’t know they are spreading it to others. Surely this is common sense. Society is not blaming the people who don’t know they are positive for the spread of HIV, they are blaming the ones who do know. I have to believe that if more people knew they had HIV less people would be spreading it. Make no mistake I am NOT saying that only people who do Not know they are positive are the cause of HIV being spread. I know full well that there are some out there who do know they have it and continue to carelessly spread it. My point is That the best way to bring about change is through the knowledge of ones status.

I don't know what kind of nirvana Mike thinks this country has turned into, but last time I checked, this is just not going to happen. First off, most people in the male straight side of this discussion, in my experience seldom admit their poz status, and far more of them than not, don't feel any obligation to disclose or use condoms in their sexual pursuits. I know this is a very general statement, but remember this is taken from my experience both in the work and in my time on the road driving my Kenworth. Most of the straight men I have met are totally unwilling to deal with their infection head on. Please don't all you straight guys beat up on me for this, but I think as you progress in your time living with this disease, you will also find my statement to be closer to the truth than not. This is not to say that Gays are free from criticism, for that would also be not true, we all know that many gays will not disclose and really could give a shit if they pass it on to anyone.

All in all, I don't think that some of the people posting in this thread have really done their homework and really don't know how HIV services in this country really operate. Many of you have followed me for a long time here, and to the nearest nit- pik, you all know I always advocate for doing your homework first. Always find out how the system works and how it is funded, because only then will you ever come close to getting anyone in government to listen to your pleas for more money to fund universal, mandatory or any other kind of complete surveillance. (testing)

Love,

« Last Edit: October 14, 2007, 12:14:37 PM by Moffie65 »

Logged

The Bible contains 6 admonishments to homosexuals,and 362 to heterosexuals.This doesn't mean that God doesn't love heterosexuals, It's just that they need more supervision.Lynn Lavne

It is very dangerous to all of our understanding to make blanket and vague statements about funding HIV/AIDS services in the United States, because if you don't know the details, then you miss out on ever solving the real issues, including Testing and Counseling.

So damn true. A good friend of mine is Co-Chair of our local Ryan White Planning Council, and the pieces he tells me really do show that this is a very involved, intricate process on various levels. Most people here have no clue, and I don't mean that in a bad way necessarily, it's just a fact. Frankly I have little clue how it all works, but I do know I have a basic knowledge of it from years on these programs that exceeds the average on this board, yet even then I can't comment fully on it all as I realize in the final equation I don't know diddly-squat. I generally DO know where to go when I need an answer, and it varies so much by locality it's even harder to offer advice outside the specifics of each state.

I have lived with HIV for 24 years. I have, in that time, also help with the founding of the largest ASO in the state. I have worked with this ASO many times including the funding process. I have work with the State department of health on Aids issues and on funding isses. I am far from ignorant on any of this issues.

Since I have come into this thread I have been personally attacked, and sworn at. I will not engage in this name calling nor will I partake in personal attacks in the topics. If any one would like to discuss this issue in a civil manor I'll will be happy to respond. I may be new to this site but I still don't see the need for people to be rude or make derogatory remarks. I would expect people to be more mature in such a setting.

I'm sorry to lead this further off topic, but I do feel I need to respond to your accusations. I think Tim Horn did a brilliant job in explaining to you why people reacted the way they did and there really isn't much more I can add to that. However, I don't think your hands are entirely clean in all this and I will tell you why.

In your very first post out of the box, no introduction, knowing nothing about you, you say this:

I read some post and nearly laughed and others I sat here in horror to think and see that people could really think in such ways.

You moderate your own site and obviously have been round long enough to know that this sets off warning bells. I would think as a moderator of your myspace you might become a bit suspicious, welcome the person and ask them to tell you a little about themselves. If I remember correctly, you didn't even reveal your status. Heck, I'm just finding about it now. Secondly, I'm sure you would agree generalizing about how an entire group thinks can certainly put people on the defensive.

Here's the deal, and I'm being completely honest. After reading a few of your posts, checking out your profile and seeing where it all linked, and maybe I'm being a bit of a conspiracy theorist, I believed there was more to this than met the eye. If I was wrong so be it.

That said, after 27 years of da aids I think sometimes we think we know it all and discount the opinions of others. I know I can be guilty of that.

Remember your 110% convictions are no more valid than any other persons 110% convictions. I would also like to suggest that if you feel like you are being attacked or sworn at, report it. Hopefully, you can put all that other stuff behind you and focus on the positive that is Aidsmeds.

Hi all I am new to this group but I have been reading and I must say there is a LOT of reading to do.

Points that shocked me;

I read in one post ( don't ask me wich one there are to many to go back through.) that people not knowing their HIV status is not the cause of the spred. You have got to be joking!!! you can not tell me that ignorance is not the problem.

Hi Mike,

Welcome.

Since I believe you are talking about my point, I thought I would address this issue.

First since you are new, may I give you first a heads up that saying it is too much of a bother to actually cite the person you are quoting (or at least whose comments you are discussing) than many may just write off your entire post as they will question if you can even bother to make certain that you have what you are quoting or talking about correct.

In this particular incident - I can say that you did not and actually misrepresented both what I said and the point I was making.

For the record , the complete quote is: It is not people not knowing their status that is the cause of the spread of the virus sexually - it is people not using condoms that is the cause of the virus being spread sexually.

Mike - I'm sure you would agree that neither ignorance nor knowledge mean one iota to the physical efficiency of virus transmission during a sexual encounter; Latex on the other hand....

You see, if you read and understood the the context of what I wrote you will note that my point is that testing doesn't necessarily equate people really knowing their correct status to begin with. It also doesn't equate people using condoms...and, by anecdotal evidence available with more than a few hours of reading material of case examples on these very forums, there are way too many people who in fact had sex without condoms simply because they thought their test results equaled their ability to do so.

Understand that I am not against routine testing at all, and I do detest the bureaucracy that plagues the medical profession and is a barrier to some testing being done. However my original post was in direct response to a statement by original poster of the validity of tying testing and counseling (which in case you misunderstood was the main cause of his reason to argue his point.)

Quote

I find it outrageous that people are not being screened for HIV and going untreated and undiagnosed for some bullshit "counseling" guidelines implemented by ass backwards and antiquated ideas.

I trust you now can appreciate my point and will not misunderstand or misrepresent it.

Now I understand,testing makes no sense because we are Godless animals without any conscious or brains and even if we know we are positive we will still fuck anything and everything that walks. What a sad and pathetic view of mankind. I hope its not true. I guess I am one of the exceptions to your rule, I know for a fact I haven't spread HIV since I became aware that I was positive,not because of latex but because I refuse to spread this shit.

I get it now, if we spend more money on rubber advertisements we can cure the spread of HIV and we can forget about testing.

You are either for or against spreading HIV. Stopping the spread of HIV should trump all other interests, those who wish all to abstain,those who wish us all to rubberize and fuck ourselves to death,and those whose concern is the stigma of HIV. Both rubbers and abstinence stop the spread of HIV,so both should be promoted. Testing will help stop the spread of HIV. There are humans with the moral integrity and will power strong enough to never spread the Virus once they know they have it. Its much more difficult to put on that rubber when you dont know if you have it or your partner has it. We can try to shift the responsibility on the entire population,but in reality the responsibility for stopping the spread of HIV lies with those infected and no one else. Not our health care system and not our government. If everyone knows their status and everyone who knows they are positive uses protection or abstains,it will stop.

If we dont have the will power to control the spread of hiv the government at some point is gonna do it and I dont think anyone wants that.

I trust you now can appreciate my point and will not misunderstand or misrepresent it. I will try my best.

I know that this is a hot topic and there are many facets to it. I will try not to step on toes as we try to work our way throught this.

Ok here goes. LOL One point I think we (at you and I) do agree on is that "routine testing" is Not a bad idea in theory. If I have not made it clear and I may not have yet, I agree with you on and I do detest the bureaucracy that plagues the medical profession and is a barrier to some testing being done.. By this I think you are referring to the special consents and forms If this is the case I whole heartedly agree. I am in favor of the HIV test being done without the need of "special consent forms". I see no reason why it should not fall under a general consent. So long as the person who is being tested is told that an HIV test will be performed as part of the standard blood work, and has the oppertunity to opt-out of it. I would not condone involuntary or Mandatory testing, except in the case of Pregnant women. In this case I feel that "Required testing" should be done for all pregnant women. My reason is simple because another life could be spared having to live with HIV, as we know it is now possible for a + mother to give birth to a negative child with proper treatment. Oh I hope I didn't step on to many toes there.

Now on to Knowing vs not knowing vs condoms I know that not every one who know they have HIV will use a condom. A sad but none the less true fact. However Many that do now know they are HIV+ do try to reduce the risk of transmission. It would be wonderful if every one used condoms every time but I know that won't happen, (if it did the human race would die off in a hundred years). So what can we do about this. Educate educate educate. Now lets say (just to make a point ) that only 40% of HIV + people will use condoms (I picked the number out of thin air) Of the next 1000 people that find out they are HIV+ from Routine testing 400 will start using condoms that would not have otherwise been using them. This will save thousands of lives even millions. It may not be the whole answer but i think it is a good place to start.

This would in the long run save billions of dollars in our already stressed health care system.

Now if I may try to cover one more facet you hit on. Counceling vs not counceling I am not sure I have said a wholoe lot on this or made myself clear on it but i will try. I think voluntary counseling is good, meaning that if a person chooses to receive counseling pre or post testing that it be made available to them. However I am not sure that madatory counseling is the best thing. My reason is simple. Not everyone will even hear what they are being told after hearing that they are HIV+ Many are in shock or dismay at the news and need time to absorb it before they can hear and understand what all of this means. Some people would choose to know as much as possible right away. I respect that and say give them all they can take. Others may choose to seek the answers after they have had time to think. For them a list of ASO's, ID specialists or even an appointment a few days down the road to discuss their options may be just what they need. I would never suggest that people be tested and told the results and sent away without any support. That would be just cruel. So that's my opinion thus far.

I know there are many other aspect of this and I am sure we will hear about them too.

In Australia the government took control of "preventing the spread" back in the mid-1980's and it worked a treat. HIV is essentially contained with the homosexual male community.

MtD

How did they do it? And by "contained with the homosexual male community", do you mean infection rates have steadied and/or declined within that community or do you mean that it has only remained a rampant problem within male homosexuals and hasn't been a significant problem outside of that group? If so, what worked for the rest of the population that didn't for male homosexuals and why do you think that was so?

I recognize that's a lot to ask, but I'd appreciate getting as much response from you and the fellow Aussies on here if/when you can. If it requires a separate thread, please do.

Nah Timmy, we'll keep it in this thread. Fucking thing's gone to shit anyway so there might as well be a few posts with some redeeming value in it.

HIV infection is Australia is almost entirely restricted to homosexually active men because needle and syringe exchange programmes were implemented in the major states in the mid 80's. Queensland and Tasmania had followed suit by the early to mid 90's.

The idea is that you keep HIV out of your drug user population and it won't spread to the heterosexual community. That's what happened here. Our infection rates are going up but that increase is almost entirely amongst homosexually active men.

Clean needles and syringes are freely available here and it's not a criminal offence to be in possession of them.

Nah Timmy, we'll keep it in this thread. Fucking thing's gone to shit anyway so there might as well be a few posts with some redeeming value in it.

MtD

We're on the same page there.

Sounds like a healthy dose of sanity prevailed with the needle exchange programs - which works great for the heterosexual portion of the population, but it also makes me wonder what your perspective is regarding how the whole thing has been handled with regard to the homosexual segment. Mind you, I get how containing the problem within that one segment actually works to the benefit of the population at large (lowered public health costs, prevention of spread to newborns, etc). I would still like to get a feel for how well you think the government has addressed the problem where people like yourself are concerned.

I trust you now can appreciate my point and will not misunderstand or misrepresent it. I will try my best.

I know that this is a hot topic and there are many facets to it. I will try not to step on toes as we try to work our way throught this....

Now on to Knowing vs not knowing vs condoms I know that not every one who know they have HIV will use a condom. A sad but none the less true fact. However Many that do now know they are HIV+ do try to reduce the risk of transmission. It would be wonderful if every one used condoms every time but I know that won't happen, (if it did the human race would die off in a hundred years). So what can we do about this. Educate educate educate. Now lets say (just to make a point ) that only 40% of HIV + people will use condoms (I picked the number out of thin air) Of the next 1000 people that find out they are HIV+ from Routine testing 400 will start using condoms that would not have otherwise been using them. This will save thousands of lives even millions. It may not be the whole answer but i think it is a good place to start.

Mike,

I only quoted the above part of your post as most of what you wrote in reply to me wasn't part of my discussion with you - perhaps you just got lost on the many facets of this discussion, as you say.

Unfortunately the key point you seem to continue to miss happens to be the main point of my argument about tying counseling and education to testing.

It's not if people will or won't use condoms because of a test result saying they have HIV, it is if people understand what a test result does mean and doesn't mean whether it says they are HIV positive or negative and then acting erroneously because of lack of education and counseling.

Early diagnosis of HIV infection and timely access to medical care can improve treatment outcomes [1] and potentially decrease the risk of transmission [2]. In this issue, Keruly and Moore [3] report a decrease in the presenting CD4+ T cell count from 371 cells/mm3 in 1990–1994 to 276 cells/mm3 in 2003–2006 among patients newly presenting for HIV care in a large academic center in the United States. Despite significant advances in antiretroviral therapy and improved services for persons living with HIV infection, our health care system appears to be less capable of detecting the disease early in its course than it was nearly 2 decades ago. The authors conclude that national implementation of the 2006 Centers for Disease Control and Prevention recommendations for routine HIV testing in health care settings [4] will improve early detection and entry to care. But will universal HIV testing be enough? Although these data support the argument for mainstream HIV testing, they also highlight the issue of universal health care coverage.

Keruly and Moore [3] report that, after stratification by demographic characteristics and HIV risk factors, median CD4+ T cell counts at presentation significantly decreased over time for women, men, black patients, and patients who reported intravenous drug use (IDU) and heterosexual exposures as HIV risk factors. One notable exception was for men who have sex with men (MSM). Presenting CD4+ T cells counts among MSM actually improved with time, from 280 cells/mm3 in 1990–1994 to 332 cells/mm3 in 2003–2006. Although proportions of patients of each sex and race remained relatively unchanged over time, the proportion of MSM and patients reporting IDU decreased, and there was a nearly 3-fold increase in persons listing heterosexual sex as a risk factor during 2003–2006.

Two questions arise. First, are these changes in patient demographic characteristics driving the decrease in the presenting CD4+ T cell counts? The answer is probably not. Although MSM were the only subjects to have improved CD4+ T cell counts over time, these patients initially had the most advanced HIV disease at presentation, with only a modest gain of 52 cells/mm3 by 2003–2006. Conversely, all other groups had much higher presenting CD4+ T cell counts in 1990–1994, with large decreases over time, ranging from 76 to 174 cells/mm3.

The second question centers on how HIV testing rates among patients receiving care at Johns Hopkins might differ from those of the rest of the nation. The 2002 National Survey of Family Growth was a population-based study of 12,571 men and women, ages 15–44 years, designed to determine the national estimate of HIV testing [5]. Overall, 50.7% of persons reported having ever been tested outside of the context of blood donation. Interestingly, testing rates were higher among African Americans and those with sex- and drug-related risk behaviors. Compared with data obtained from the 1995 National Survey of Family Growth study, which included only women, testing rates among African American women significantly increased, from 45.3% to 65.6%. If testing rates among African Americans are increasing nationally, then why do data from Johns Hopkins (more than three-quarters African American) suggest the opposite? The explanation may lie in where people receive their HIV testing. In the 2002 National Survey of Family Growth study, many persons received HIV testing from a private physician (39.5%) or a managed care organization (5.2%). In contrast, only 17.3% of all tests were performed in a public health clinic. The use of public clinics among the subgroup of persons with low incomes was higher, at 31.4%. As a provider receiving Ryan White CARE Act funding, the Johns Hopkins patient population contains mainly underinsured persons [6] who likely lacked general health care before their diagnosis of HIV infection. In the early 1990s, HIV care was largely concentrated in academic institutions or public facilities with access to clinical trials. In more recent years, HIV specialty care has become more available in managed care settings and among private physicians. Potentially, the Johns Hopkins cohort today contains fewer insured patients and serves a more disenfranchised population, with fewer opportunities for HIV testing, than was the case in the early 1990s. Because underinsured persons most often gain access to the health care system through public health clinics, emergency departments, and urgent care facilities, and these settings often have lower HIV testing rates than do private physician offices and managed care organizations [5], it is plausible that the Johns Hopkins HIV patient population is receiving diagnoses at a later stage simply because of the health care systems that are available to them.

Another sobering finding in this study was the absence of improvement in the time from diagnosis to presentation for care among women, African Americans, and those with heterosexual risk factors. Although multiple factors likely contribute to this delay, those without prior health care may seek access to resources less efficiently even when resources are available. A universal health care system may help remedy this. As an example, universal health care is practically available in the United States for pregnant women, with an estimated 99% of pregnant women obtaining prenatal care [7]. Approximately 70% of women reported that they received HIV testing during prenatal care [7]; therefore, HIV infection is diagnosed earlier among pregnant women than among nonpregnant women [8]. In addition, low-income, HIV-infected women who had prenatal care were more likely to receive antiretroviral therapy during pregnancy and to have access to other medical services, such as substance abuse treatment, in the postpartum months [9]. Among pregnant women, primary care providers play a central role in HIV testing, access to antiretroviral therapy, and referral for other health care needs. We anticipate that similar benefits would occur for under- or uninsured, nonpregnant adults if access were available to primary care before HIV infection was diagnosed.

HIV disease is a disease of poverty. In the United States, HIV infection disproportionately affects uninsured, low-income persons [10, 11], who constitute a vulnerable population that often has multiple health care needs. Despite these challenges, HIV infection–related morbidity and mortality continue to decrease [12]. Undoubtedly, much of this success is attributed to government-sponsored programs, such as the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act, which provides access to medical care after the diagnosis of HIV infection. Perhaps the best way to improve the prevention of HIV infection and decrease transmission is to provide similar health care services before HIV infection to those with the greatest need and highest risk for HIV infection. Although not completely analogous to the situation in the Unites States, in settings where universal health care systems are in place (i.e., Western Europe), HIV infection is still being diagnosed late among underserved, immigrant populations [13–16]. Taken together, these findings suggest that "universal" HIV testing also requires "universal" health care for there to be a significant impact on diagnosing HIV infection at the earliest stage possible [14]. As the United States and other resource-wealthy countries move forward to build health care infrastructure and scale-up antiretroviral therapy in resource-limited settings, it is a shameful commentary on our own health care system that the average CD4+ T cell count before the initiation of antiretroviral therapy in North America is similar to that of some underdeveloped countries in Africa [17].